Entrevista en el SENA

demonstrates in descriptive nature the key categories impacted by leadership and the relationship of these with the core theory and resultant consequences. Double arrows indicate the dynamic nature of this model and the relationship between the follower and leader. It is also recognized there is overlap of themes within each category further supporting the notion of the shifting

nature of impact of the leader on the follower. The following sections will describe the dimensions within each key category and give examples from the data obtained.

Figure 2. Core Theory Model.

4.2.3 Emotions.

4.2.3.1 Ethics of care. This dimension identifies with the nurses’ emotions in regard to

the front-line leadership’s engagement in ethical decision making. When asked about the process of patient care and current patient safety issues, one nurse identified, “…it was a very stressful night because there were no beds and there was not enough staff to care for the people we had”. Another nurse was concerned with the state in which the patients were being seen, “we are now putting people in chairs”. When asked about leadership’s role in this, one nurse

commented, “they are just trying to move people” and another “there is all this shadiness going on too I think”. Emotions ranging from sympathy to frustration were expressed based on patient context and the care provided. One nurse related her sense of dismay in a conversation she had

with a patient’s family member following an adverse event, “but it is just so hard to say that to someone and they are agreeing. So I don’t know, there is not much I can do right now but say I am sorry.” Based on the ethical decision making of leadership and current processes

implemented within the unit, the nursing staff responded emotionally to the resultant patient care provided.

In respect to leaderships’ knowledge about the impact of their decision making on the staff so far as ethics were concerned, a range of themes were identified including nurses’ emotions of being upset and angry to a sense of hope and ‘benefit of the doubt’. One nurse commented, “I don’t think they are trying to bring the morale down and I don’t know if they know” [front-line leadership], “I don’t know if they know how bad it is out there on the floor”, and another, [senior leadership] “you know, so there has got to be pressure there too. But I don’t know, you can’t take it out on your staff, right? Or else they are not going to be happy working there either”. An overlap of emotion and self-awareness was present within the questioning by nursing staff based on the current morale of the unit.

4.2.3.2 Vision alignment. A common theme amongst the nurses participating in the

interview process and completing the open-ended questions was focused around the vision of leadership and the incompatibility with their own beliefs and the impact this had on their emotions. One nurse responded, when asked about the impact of the process change, “while I understand the wait times and we don’t want the bad press but there does not seem to be a concern with how that affects us, and us feeling swamped and overwhelmed”. Another

responded [in regard to trialing out the new process], “when we did a trial they sort of gave out an award to who did best that day, I felt this was inappropriate because that is not what we are here to do” and another “[in respect to an AEMS report on unsafe workload assignment

leadership responded] so ok we just need more beds is that it? [nursing responded] no…. I was doing things in the hallway and it became unsafe”. Alignment of beliefs and values were a significant factor in the emotional response of the nurses to their work environment and process change.

4.2.3.3 Spectrum and validation. In this key category, elements of empowerment, fear,

job satisfaction, and validation were described by the nurses. In general, nurses felt a lack of empowerment within their work environment and expressed this emotional impact on their professional practice and emotional state. Described by one nurse, “they sort of tell you how to do your job when you already know how to do it, which can be a little bit more frustrating”. Another discussed the inabilities of the staff to ‘push back’ on the process changes that occurred. Multiple nurses commented in writing and word, on feelings of aggravation and fear when

associated with the process of patient care. Concerns were voiced strongly by one participant in regard to care of patients within the new patient flow system, “I hope that you are not going to ‘kick the bucket’ like in a day or 2 days or 2 hours because I missed something, I missed a symptom that should have told me that this was really critical”. Lack of control and confidence in the process change further impacted the emotions of the nurses and their beliefs in their own abilities to care for patients under those conditions.

The nurses delved further into their feelings when discussing what influenced their contentment within their role. The majority of nurses in survey and interview responses

discussed the need to feel appreciated by front-line leadership. One nurse spoke, “If somebody told me “I really appreciated like the work you did today” I would be happy with that”.

valued organizational member, and the need for leadership, in one way or another, to demonstrate this to the individual staff.

The emotional impact in respect to validation of feelings and actions was identified during the interview when a discussion was initiated on the nurse’s experience of filling out an AEMS report and in survey comments. Contrasting opinions were noted. One nurse expressed a positive experience, “I saw action quickly, I was taken very seriously, and it was a positive impact”. A second nurse expressed the opposite feeling, “I wrote an incident report and never heard one thing back from them. So it is kind of dependent on what it is. I don’t know it’s hard. [Upset with lack of support and validation of reporting]. I mean, I used to be very happy”. In all contexts, the nurses expressed a need for validation and a distinct emotional response to an absence of or the presence of validation and overall confidence in self being affected by either form of validation.